welcome to night eating!

educating yourself about eating disorders...

a menu of sites within the network
what's your relationship with yourself like?
obesity
still searching? click here!
are you mindful & aware?
where does your energy go to?
nobody's perfect...
dieting?
you are a valuable person
welcome to night eating!

A not for profit network of self-help websites.

Welcome! I hope I can help you find what you're looking for! Anytime you see an underlined word in a different color you're being offered an opportunity to learn more than what you came here for. It's important to understand the true meanings of your emotions and feelings as well as many other topics that are within this network. This entire network is set up to help those who want to help themselves find a sense of peace in their lives - discover who resides within and recover from whatever life has dealt you. Clicking on the underlined link words will open a new window so whatever page you began on will remain waiting for you to get back to it!

 

If you can't find what you're looking for here, scroll down to see an entire menu of what is offered within the emotional feelings network of sites! 

 

kathleen

There's a new site in the network! I am almost finished completing each page, but I can't wait anymore to tell you all about it! Please pay it a visit soon! It's an important topic!

                                                                                    

click here if you're disappointed in yourself....
click here if you're disappointed in yourself....
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click here to send me an e-mail... anyone need to ask a question, say hello or just need to chat....  click the above link to send email now!

education is the key to understanding what is happening to you every night...
 
the following information about eating disorders, abuse and night eating can be read over and sorted through to find symptoms that may compare to what you're experiencing...

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dis·or·der   
n.
  1. A lack of order or regular arrangement; confusion.
  2. A breach of civic order or peace; a public disturbance.
  3. An ailment that affects the function of mind or body: eating disorders & substance abuse. To disturb or interrupt the regular & natural functions of (either body or mind); to produce sickness or indisposition in; to discompose; to derange; as, to disorder the head or stomach.

tr.v. dis·or·dered, dis·or·der·ing, dis·or·ders

  1. To throw into confusion or disarray.
  2. To disturb the normal physical or mental health of; derange.

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more information? click here & learn more about eating disorders in general...

Click here to join nighteating101
Click to join nighteating101

update! 7/19/09 we currently have 75 members! check in & visit!
 

Many of the articles posted within the emotional feelings network of sites were found at the website above... thanks so much & be sure to visit them! There's so much information to be found there!
kathleen

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welcome to night eating!
 
Please read the following as it contains important information for optimal site navigation!

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as you're reading thru the info on this page, ask yourself where your head is at this minute...
 
are you taking in the information with an open mind? are you aware of the possibilities that are available for you to tune in on?
 
"Eating disorders occur most commonly in adolescents & young adults & are 10 times more common in females than in males."
 

from: Diagnosis of Eating Disorders in Primary Care

SARAH D. PRITTS, M.D., and JEFFREY SUSMAN, M.D.
University of Cincinnati College of Medicine, Cincinnati, Ohio

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the faces of eating disorders...

Causes of Eating Disorders

While eating disorders may begin with preoccupations with food and weight, they're most often about much more than food.

click here for more info 

Eating disorders are complex conditions that arise from a combination of:

  • long-standing behavioral, emotional, psychological, interpersonal and social factors

Scientists and researchers are still learning about the underlying causes of these emotionally and physically damaging conditions.

We do know, however, about some of the general issues that can contribute to the development of eating disorders.

People with eating disorders often use food and the control of food in an attempt to compensate for feelings and emotions that may otherwise seem overwhelming.

For some, dieting, bingeing and purging may begin as a way to cope with painful emotions and to feel in control of one’s life, but ultimately, these behaviors will damage a person’s physical and emotional health, self-esteem and sense of competence and control.

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stay with me now...
let's look at some of the above factors. competency shows up in several important areas. one of the most pertinent factors that ties in with social, family and genetic factors that can cause disordered eating habits is - "change." read the article below and understand how it ties in to the "bigger picture" which is - "who develops an eating disorder and why"?
 
"Unfortunately, the diagnosis of eating disorders can be elusive and more than one half of all cases go undetected."
 
Becker AE, Grinspoon SK, Klibanski A, Herzog DB. Eating disorders. N Engl J Med 1999;340:1092-8.

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The 3 Key Components to Any Successful Change - By Mary Ann Bailey, MC

We live in a world that's constantly bombarding us with changes. One would think that with all that practice, we'd be fairly adept at navigating the change process.

But the truth of the matter is, making any kind of intentional change in our life can be difficult.

transitions, changes, they happen....

When we decide to change something in our lives, we make the decision to swap out the old and familiar for something new and unknown. This upsets our equilibrium and can be frightening and somewhat disorienting.

But we can lessen these feelings of uncertainty and ensure ourselves a greater chance of success, if we initially take the time to address the 3 key components necessary for any successful change.

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These components are:

COMMITMENT: (goes to make a point about commitment on the additional info on eating disorder's page!)

Most of us believe when we decide to make a change in our lives that we're fully committed to doing what it takes to make that change happen.

But commitment can be a tricky thing.

There can be part of us who is truly committed to the change, while there may be other parts of us who have no desire to change.

This phenomenon is known as having "competing commitments".

Competing commitments create resistance and having to deal with resistance is what often causes us to give up before we reach our goal.

Example: Megan wants to start an exercise program to lose weight and increase her energy level. She signs up for a class at health club and is excited about getting started. The first few mornings go well, but then she begins to notice that her enthusiasm is waning.

Megan begins to sabotage her progress by skipping classes and telling herself that her instructor isn’t really sensitive to her needs. She feels that she's still committed to losing weight and doesn't really understand where her resistance is coming from.

Resistance is the red flag for competing commitments. In Megan's case the competing commitment turned out to be her desire to spend time with her friends. She had a weekly get-together that she assumed she no longer could attend because she had to get up early in the morning to exercise.

Megan saw her dilemma as an either/or situation. She believed that she would have to give up one activity in order to have the other.

Once she realized that that wasn’t actually true – that her friends would be willing to change their meeting time – Megan began to relax and her resistance disappeared.

COMPETENCE:

The 2nd key element is competence. Competence means having the skills necessary to make the change happen, or having the time, energy and ability needed to acquire the skill.

Example:
Lucy
was having trouble at work with one of her workers, Kris. Every time Lucy would try and talk to Kris about her negative attitude, the conversation would end up very heated and both women would leave feeling upset and unheard.

Lucy was committed to finding a way to try and help Kris see how her attitude was affecting her team and the whole organization.

After several less-than-satisfactory attempts at trying to solve the problem herself, Lucy realized that she wasn't as skilled at having these kinds of conversations as she needed to be. At this point she had to decide whether or not she wanted to commit to strengthening her ability to have difficult conversations.

Lucy knew she was capable of learning what was needed and she was committed to seeing her problem through; so she decided to hire a consultant to help her address the situation.

STRUCTURE:

The last element is structure. Structure is the most important element in making change happen, but it's very often overlooked.

Structure is what holds the change process together. It refers to any resources you might need, such as Megan's exercise class or Lucy’s consultant. It also refers to the systems needed to support you as you're working through your change.

Structure provides the safety net. It allows you to share the burden of change with others, therefore lightening your load. It also helps ensure success, as a team effort is usually more successful than one person going it alone.

Who do you call when you're feeling stuck, discouraged, or you want to quit?

Who do you celebrate with when you're successful?

Who'll be there to prod you, encourage you and remind you how great you are and that what you're doing is wonderful?

However, we often forget to put this piece into place and then we're left to face the struggles by ourselves.

We can become overwhelmed and give up feeling defeated and discouraged. Making sure you have a strong structure in place to support you through your change can keep this from happening.

Although the process of change is often described as difficult, it also can be an incredibly exciting journey.

Change is the source of energy that keeps us moving forward and allows us to discover new things about ourselves and our world. But, as with all journeys, the better you prepare for it, the smoother your trip will be.

So, the next time you're faced with a change, make sure you're clear about your commitment, realistic about your competence and that you've taken the time to create a solid structure to support you. I think you'll be pleasantly surprised with the end results.

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okay... that's what it takes to be successful with changes in your life...
but what happens if you feel like you're not competent, you can't commit and you feel that you aren't strong enough to get things together yourself & you have no support or structure?
 
how do you cope with change then? do you eat? at night when your defenses are sleeping? think about it!
 

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Family factors

Some people with eating disorders say they feel smothered in overprotective families.

Others feel

Parents who over-value physical appearance can unwittingly contribute to an eating disorder. So can those who make critical comments, even in jest, about their children's bodies.

Families that include a person with an eating disorder tend to be overprotective, rigid and ineffective at resolving conflict.

Sometimes mothers are emotionally cool while fathers are physically or emotionally absent.

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excerpt: Excerpts from the Archives of the Narcissism List - Narcissists & Depression - (one reason for being emotionally absent)

"If by "depression" we also mean "numbness" then most narcissists are simply numb, emotionally absent, non-existent. Their emotions aren't accessible, not "available" to them. So, they inhabit a grey emotional twilight zone.

They regard the world thru a glass opaquely. It all looks false, fake, invented, contrived, in hues of wrong. But they don't have a sense of living in prison. I have been to prison.

Once in it, you remember there's an "outside" &you know there's a way out. Not so in narcissism. The outside has long faded into oblivion, if it ever existed. And there's no way out."

back to the above article!

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At the same time, there are high expectations of achievement and success. Children learn not to disclose doubts, fears, anxieties and imperfections.

Instead they try to solve their problems by manipulating weight and food, trying to achieve the appearance of success even if they don't feel successful.

Research at Oregon Health and Science Univ. in Portland has produced strong evidence that exposure to stress (abuse, neglect, loss of a parent) in childhood increases the risk of behavioral and emotional problems (anxiety, depression, suicidality, drug abuse - phenomena frequently associated with eating disorders) in teenagers and young adults. For details, see the OHSU press release.

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more examples of emotionally cool or emotionally absent parenting:
 
Emotionally Absent Father
That's what I believe has plagued my wife for many years. Her father was at home, but wasn't there for her or her sister. Mother and father finally divorced when she was around 11 or 12. Sister got married young, had kids, husband abusive, messy divorce.

All predictable as effects of an "emotionally absent father".

What I'm looking for are articles on this that relate specifically to daughters and how it affects their own marriages.

With a possible cause, one can find a possible cure.

And possibly find happiness.

Can you help me find happiness again?

I did all the possible Google searches on this but nothing was concrete and specific on how this could affect a daughter in her own marriage later in life.

I see a glimmer of light at the end of a dark tunnel.

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In addition, other research suggests that daughters of mothers with histories of eating disorders may be at higher risk of eating disorders themselves than are children of mothers with few food & weight issues.

Children learn attitudes about dieting & their bodies thru observation. When mom is dissatisfied with her body & frequently diets, daughters will learn to base their self-worth on their appearance, says Christine Gerbstadt, spokeswoman for the American Dietetic Association.

Alison Field, lead author of a Harvard study of peer, parent & media influences on children's dieting behavior & body image attutudes (Pediatrics, Vol. 107 No. 1 January 2001, pp. 54-60) adds that "even small cues - such as making self-deprecating remarks about bulging thighs or squealing in delight over a few lost pounds - can send the message that thinness is to be prized above all else."

According to a report published in the April 1999 issue of the International Journal of Eating Disorders, mothers who have anorexia, bulimia, or binge eating disorder handle food issues & weight concerns differently than mothers who have never had eating disorders.

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Patterns are observable even in infancy.

They include:

  • odd feeding schedules
  • using food for rewards
  • punishments
  • comfort
  • other non-nutritive purposes
  • concerns about their daughters' weight

Still to be determined is whether or not daughters of mothers with eating disorders will themselves become eating disordered when they reach adolescence.

Also, if mothers & fathers preach & nag about junk food & try to limit their children's access to treats, the children will desire & overeat these very items.  (click here to read other info)

A recent study (American Journal of Clinical Nutrition. 2003;78:215) indicates that when parents restrict eating, children are more likely to eat when they're not hungry.

The more severe the restriction, the stronger the desire to eat prohibited foods. These behaviors may set the stage for a full blown eating disorder in the future.

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OHSU Research Reveals Likely Connection Between Early-Life Stress and Mental Health Problems During The Teenage Years (November 16, 2005)

Research to be presented Wednesday, Nov. 16, at the Society for Neuroscience Meeting in Washington, D.C. 

WASHINGTON, D.C. -  Research conducted at the Oregon National Primate Research Center at Oregon Health and Science University and at the University of Pittsburgh suggests a strong link between significant stress early in life and the increased incidence of mental health problems during adolescence.

The research strengthens the case for proactive treatment or counseling of children who undergo a significant early-life stress. The research is being presented during the Society for Neuroscience meeting in Washington, D.C., Nov. 12-16. The meeting is one of the largest and most respected gatherings of neuroscientists in the world.

Both past research and human observation reveal that children who experience early-life stresses such as:

have an increased risk of developing attachment disorders.

Later in childhood, these same children show an increased incidence of manifesting some types of  behavioral and emotional disorders, including:

Both genetic factors and life experiences appear to play a role in the causes of these mental health disorders.

"Until now only human observation and theories have suggested that early-life stresses can also lead to problems as far away as the teenage years," said Judy Cameron, Ph.D., a senior scientist in the divisions of Reproductive Sciences and Neuroscience at the OHSU Oregon National Primate Research Center.

Cameron also is a professor of psychiatry at the University of Pittsburgh. "By studying a species that has responses to early-life stresses that are very similar to young children, we can get a developmental picture that is much clearer than in humans."
 
Interpretation of human epidemiological studies are often difficult because children experiencing early-life stresses frequently have exposure to many other situations, such as:

both of which can increase the incidence of mental health problems.

In contrast, for this study researchers were able to rear rhesus macaque monkeys with a one-time stress exposure, followed by rearing in a very stable social environment.

The findings provide strong evidence that stress exposure early in life can have dramatic, long-lasting effects that persist into the teenage years and perhaps even adulthood, even in the face of an otherwise stable rearing, such as would be recommended for children experiencing early life stresses

"Some of the most important clinical questions targeting early intervention for behavioral and emotional problems in youth will require a deeper understanding of the unique vulnerabilities linked to neural changes at puberty and adolescence - and more specifically, how these adolescent changes interact with earlier vulnerabilities such as major life stressors and social adversity early in life,"

said Ronald E. Dahl, M.D., the Staunton Professor of Psychiatry and Pediatrics at the University of Pittsburgh.

"This line of study by the Cameron lab is providing unique insights into these developmental interactions in ways that can't be achieved in controlled studies in humans."

The researchers studied 16 small social groups of monkeys for a 3 year period. Because monkeys mature at a much more accelerated pace than humans, a monkey 2 to 4 years old would correspond to a human teenager in regard to mental and physical development.

To ascertain the impacts of an early-life stress, certain monkeys had their mothers removed from the social group at various stages early in life. These monkeys continued to be raised in the stable social groups with other monkeys - similar to a human child that loses a parent but continues to be raised in their family.

Some infant monkeys had their mothers removed from the social group when they were 1 week old. These infants went on to be alert and active, but to show less than normal interest in social interactions.

Their behavior looked similar to children who develop a form of attachment disorder characterized by withdrawal from social interactions.

Some infant monkeys had their mothers removed from the social group when they were 1 month old. These infants went on to show increased clinginess and seek social comfort more than normal. Their behavior looked similar to children who develop a form of attachment disorder characterized by indiscriminate clinginess.
 
In adolescence, one-week separated monkeys continued to spend less time in social contact with other monkeys and showed more time displaying
self-comforting behaviors, such as snuggling a toy or even sucking their thumb, especially when they were placed in mildly stressful situations.

In adolescence they also showed less inclination to explore novel, interesting situations - this has been taken as a marker of anxiety in human studies.

In contrast, adolescent monkeys who had experienced maternal separation at 1 month old continued to show significantly more time in social contact compared to monkeys not experiencing the stress of early maternal separation.

However, they also developed several new behavioral characteristics in adolescence. Like one-week separated monkeys they, too, developed a reduced inclination to explore novel, interesting situations.

And, they also developed "freezing" behavior in response to fearful stimuli - again a characteristic of increased anxiety in humans.

"Why there's an increase in the expression of anxious behaviors in individuals experiencing early-life stress during puberty remains unknown," said Cameron.

"However, we now know this occurs both in humans and in nonhuman primates. We hope that the increased ability to study behavior and pubertal development in nonhuman primates will allow us to more thoroughly address this issue.

We can speculate that hormonal changes that occur with puberty interact with the neural circuits whose function is modulated by early-life stress, but identifying such potential mechanisms will take further work. We're encouraged that the nonhuman primate model will allow this type of study."

Another issue that has been raised in clinical studies of children experiencing early life stress, is whether the timing of puberty is affected by such stress exposure.

Girls experiencing sexual abuse early in life have been reported to go through puberty at earlier ages than non-abused girls.

However, in this report, the researchers tracked reproductive hormones and the incidence of menstrual bleeding in female monkeys throughout puberty and found that there were no differences in the timing of puberty onset in animals that had experienced early-life stress compared to control animals.

This finding suggests that early puberty onset may not be a response to all types of early-life stress, but may be more specific to girls experiencing early sexual abuse.
 
Support for this research was contributed by the John D. & Catherine T. MacArthur Foundation.

The ONPRC is a registered research institution, inspected regularly by the United States Dept.of Agriculture. It operates in compliance with the Animal Welfare Act & has an assurance of regulatory compliance on file with the National Institutes of Health.

The ONPRC also participates in the voluntary accreditation program overseen by the Association for Assessment & Accreditation of Laboratory Animal Care International (AAALAC).

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"i just gotta say it..." a personal comment about the above information....
 
I'm continually evolving in my personal growth & recovery. Today is different than yesterday & miles away from last year... but light years away from the day that I opened this website.
 
Sometimes Ii feel unsure about myself. it's a cautious case of curiosity actually because I'm feeling as though i don't know myself anymore. I'm someone i've never been before. I say this because I'm not - for the most part, I still have my moments - living in the shadows of an intense monster called "fear."
 
I still get anxious at times, can be triggered into hypervigilence at any moment... but for the most part... i'm calm... very calm.
 
I've told people that have emailed me that there's no end to an eating disorder. I believe it. I've been waking at night... going straight to the kitchen... just like back in the day when I was night eating... only difference being... i have control over eating.
 
I don't night eat anymore. I could, but I choose not to. I usually get a drink of some kind, like water or juice or sometimes I just get a cup of coffee & stay up & work for awhile. i still don't sleep well. I still wake up, but I can stay in bed if I don't have to go potty.
 
It's taken me about 5 years to get here from the hell I was in as an active night eater.
 
I'm calm, I'm happy, I still have post traumatic stress disorder & I could easily fall into a depression if I let myself.
I'm just more aware of these things now. i understand when i'm upset about something. i try to sit with the feeling or emotion & recognize what it is. i try to identify it.
 
This takes some time if I want to get it right. I may think I know what I'm feeling, but I'm wrong sometimes. I have to really put my mind to it.... it doesn't come naturally to me. then I have to read about that feeling or emotion. I have to understand it. i want to know what the emotion or feeling I've been experiencing can do to my mind & to my body if I let it get out of control.
 
i concentrate on other feelings and emotions that seem to stem from what i've identified, named and felt. i write them down. i think about them... i give them their due. i actually say to myself, i feel sad. it's okay to feel sad. i know what sad feels like. it's not as bad as it used to be for me. i can do sad without falling apart. what do i need to do for myself in my sadness that will relieve it or make it go away?
 
this is part of recovery.... it's not a single thing that you do... it's not a single pill that you take or a single counseling session... it's life .. in a different color, a different direction, but you're aware of where you're going... and you make choices... on purpose... thinking about consequences, circumstances and about myself.
 
i like it. i'm trying to develop it more, mold it, feel it all, love it all... love myself... i'm still trying to really love myself.
 
kathleen

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Social factors

Sometimes appearance-obsessed friends or romantic partners create pressure that encourages eating disorders. Ditto for sorority houses, theatre troupes, dance companies, school cliques and other situations where peers influence one another in unhealthy ways.

People vulnerable to eating disorders, in most cases, are experiencing relationship problems, loneliness in particular. Some may be withdrawn with only superficial or conflicted connections to other people.

Others may seem to be living exciting lives filled with friends and social activities, but later they will confess that they didn't feel they really fit in, that no one seemed to really understand them and that they had no true friends or confidants with whom they could share:

- the basis of true intimacy.

Often they desperately want healthy connections to others but fear criticism and rejection if their perceived flaws and shortcomings become known.

excerpt: Anred.com website: Causes of Eating Disorders

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Psychological Factors that can Contribute to Eating Disorders:

Interpersonal Factors that Can Contribute to Eating Disorders:

  • Troubled family and personal relationships

  • Difficulty expressing emotions and feelings

  • History of being teased or ridiculed based on size or weight

  • History of physical or sexual abuse

Social Factors that Can Contribute to Eating Disorders:

  • Cultural pressures that glorify "thinness" and place value on obtaining the "perfect body"

  • Narrow definitions of beauty that include only women and men of specific body weights and shapes

  • Cultural norms that value people on the basis of physical appearance and not inner qualities and strengths

Other Factors that can Contribute to Eating Disorders:
Scientists are still researching possible biochemical or biological causes of eating disorders. In some individuals with eating disorders, certain chemicals in the brain that control hunger, appetite and digestion have been found to be imbalanced. The exact meaning and implications of these imbalances remains under investigation.

tape measures

Eating disorders are complex conditions that can arise from a variety of potential causes. Once started, however, they can create a self-perpetuating cycle of physical & emotional destruction.
All eating disorders require professional help.

while i didn't have anorexia or bulimia, night eating is almost more frustrating because when you tell professionals your symptoms, they look at you like you're crazy... no lie! they look at you like you're just plain off your rocker...
 
i've had mental health professionals laugh at me when i told them about my symptoms...
 
i have had doctors tell me that i just can't control my stomach...
 
night eating is very dangerous.... you can eat so much food at night so you can't eat in the daytime... you eat, sleep, wake up, starve... i fell asleep with food stuffed into my mouth, choking....

Biological factors

According to recent research (Archives of General Psychiatry 2006; 63:305-312) Genetic factors account for more than half (56%) of the risk of developing anorexia nervosa. Work on the genetics of bulimia and binge eating continues.

Temperament seems to be, at least in part, genetically determined. Some personality types (obsessive-compulsive and sensitive-avoidant, i.e.) are more vulnerable to eating disorders than others.

New research suggests that genetic factors predispose some people to anxiety, perfectionism and obsessive-compulsive thoughts and behaviors.

These people seem to have more than their share of eating disorders. In fact, people with a mother or sister who has had anorexia nervosa are 12 times more likely than others with no family history of that disorder to develop it themselves. They're 4 times more likely to develop bulimia. (Eating Disorders Review. Nov/Dec 2002)

Studies reported in the New England Journal of Medicine (3/03) indicate that for some, but not all, people heredity is an important factor in the development of obesity and binge eating.

Now there are suggestions that women who develop anorexia nervosa have excess activity in the brain's dopamine receptors, which regulate pleasure. This may lead to an explanation of why they feel driven to lose weight but receive no pleasure from shedding pounds. (Journal of Biological Psychiatry; July 2005. Guido Frank, et al.)

Also, once a person begins to starve, stuff, or purge, those behaviors in and of themselves can alter brain chemistry and prolong the disorder. i.e., both undereating and overeating can activate brain chemicals that produce feelings of peace and euphoria, thus temporarily dispelling anxiety and depression.

In fact some researchers believe that eating disordered folks may be using food to self-medicate painful feelings and distressing moods.

A note about stress and overeating:

New research suggests that there's a biological link between stress and the drive to eat.

Comfort foods - high in sugar, fat and calories - seem to calm the body's response to chronic stress.

In addition, hormones produced when one is under stress encourage the formation of fat cells.

In Westernized countries life tends to be competitive, fast paced, demanding and stressful. There may be a link between so-called modern life and increasing rates of overeating, overweight and obesity. (Study to be published in Proceedings of the National Academy of Sciences. Author is Mary Dallman, professor of physiology, University of California at San Francisco [2003].)

Age and brain maturation / impairment play a role also: When an eating disorder begins in childhood or adolescence, it may be especially hard to deal with.

Magnetic resonance imaging provides evidence the brain continues to develop and become increasingly complex until people are in their early 20s.

The parts of the brain that effectively plan ahead, predict consequences and manage emotional impulses are just not fully operational in children and teens. Teens may insist they are mature, but the research shows there's a lot more brain wiring that needs to be done before the he or she is truly an adult.

Think about it: if teens were truly mature, they would:

  • always drive carefully
  • always wear seatbelts
  • never consume alcohol or other drugs
  • always think about the real-life consequences of their choices and behaviors

Clearly this isn't the case. In the same way, teens think their lives are charmed, that they can escape the negative consequences of disordered eating, that they won't get caught in the obsessions and compulsions generated by dieting and the metabolic chaos of binge eating and purging.

It's a sad, but predictable, reality that they're mistaken. (David Walsh, Why Do They Act That Way? Free Press, Simon & Schuster, 2004.)

And if that weren't enough, even when the person is well past 20, starvation, chronic dieting, binge eating and purging can damage brain wiring and disturb neurochemical processes, impairing the very centers needed to make healthy choices.

anorexia nervosa:

never thin enough....

What is anorexia?

Anorexia nervosa is often considered to be a type of eating disorder in an entire spectrum of eating disorders. It's also & more importantly, a "psychological disorder."

It's a condition that goes beyond out-of-control dieting. The person with anorexia initially begins dieting to lose weight. Over time, the weight loss becomes a sign of mastery & control.

The drive to become thinner is actually secondary to concerns about control &/or fears relating to one's body. The individual continues the endless cycle of restrictive eating, often to a point close to starvation, in order to feel a sense of control over the body. This becomes an obsession & is similar to an addiction to any type of drug or substance.

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Anorexia generally affects females,but can affect males as well & while anorexia typically begins to manifest itself during early adolescence, it's also seen in young children & adults.

What causes anorexia?

At this time, no definite cause of anorexia nervosa has been determined. However, research within the medical & psychological fields continues to explore possible causes.

Some experts feel that possible underlying causes can relate to demands from society & the family.

For many individuals with anorexia, the destructive cycle begins with the pressure to be thin & attractive.

A poor self-image compounds the problem.

Other researchers feel that this disorder can stem from a particular dysfunction often seen in families of anorexia patients. In this particular type of dysfunction, family members become so interdependent that each can't achieve their identity as an individual.

Thus, family members are unable to function as healthy individuals & are dependent on other family members for their identity.

Part of this dysfunction includes a fear of growing up by the children of these families, especially girls.

Restrictive dieting may prevent their bodies from developing in a normal manner & in their thinking, restricts the maturational process & maintains the parent-child relationship that the family has come to rely on.

Although no organic cause for anorexia has been identified, some evidence points to a dysfunction in the part of the brain (hypothalamus) which regulates certain metabolic processes.

i ask myself when i read thru the descriptions of anorexics, "can i identify with any of this?" part of it rings an alarm in my brain and in my heart...
 
the part above that says, anorexic girls sometimes don't want to grow up...
i get that. if you're anorexic - can you think back in time to when you were a little girl who was adored by your father... you were "daddy's little girl," and then suddenly something happened and he began to ignore me.
 
he acted repulsed by the thought of my climbing into his lap. i can remember wanting to be that baby or child that was "young enough" to be allowed to be comforted by a parent in the night when they needed it.
 
i can remember feeling lost. i can remember wanting more than anything to be loved by my parents. i needed them but they wouldn't tell me they loved me. they used to when i was very little, but now as i was growing up, they just seemed to walk by me without ever noticing i was there....
 
kathleen

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who am i?

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How is anorexia diagnosed?

Anorexia nervosa is a complicated disorder to diagnose. why?

  • Individuals with anorexia often attempt to hide the disorder.

  • Denial & secrecy frequently accompany other symptoms.

  • It's unusual for an individual w/anorexia to seek professional help because the weight loss itself isn't viewed as a problem.

The actual diagnosis isn't made until there are other medical complications. The individual is often brought to the attention of a professional by family members only after a marked weight loss has occurred.

When anorexics finally come to the attention of the health professional, they often lack insight into their problem & may be unreliable in terms of providing accurate information. Therefore, it's often necessary to obtain information from parents or other family members in order to evaluate the degree of weight loss & extent of the disorder.

The actual criteria for anorexia nervosa are found in the American Psychiatric Association's Diagnostic & Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

There are 4 basic criteria in the diagnosis of anorexia.

  • The individual's refusal to maintain body weight at or above a minimally normal weight for age & height

  • Body weight less than 85% of the expected weight is considered minimal.

  • An intense fear of gaining weight or becoming fat, even though the person is underweight

  • Self-perception is grossly distorted & weight loss isn't acknowledged

  • In women who have already begun their menstrual cycle (postmenarchal), at least 3 consecutive periods are missed (amenorrhea), or menstrual periods occur only after a hormone is administered

The DSM-IV further identifies 2 subtypes.

In the Binge-Eating / Purging Type, the individual regularly engages in binge-eating or purging behavior which involves self-induced vomiting or the misuse of laxatives, diuretics, or enemas during the current episode of anorexia.

In the Restricting Type, the individual severely restricts food intake, but doesn't engage in the behaviors seen in the Binge-Eating Type.

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What effects can anorexia have?

Anorexia can have dangerous effects on all aspects of an individual's life.

It can affect other family members as well. Being seriously underweight can lead to depression & social withdrawal. The individual can become irritable & easily upset & have difficulty interacting with others.

Sleep can become disrupted & lead to fatigue during the day. Attention & concentration can decrease. All of these features can negatively affect one's daily activities.

Diminished interest in previously preferred activities can result. Some individuals also have symptoms that meet the criteria for a Major Depressive Disorder.

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Most individuals w/anorexia become obsessed w/food & thoughts of food.

They think about it constantly & become compulsive about eating rituals. They may collect recipes or hoard food. Additionally, they may exhibit other obsessions &/or compulsions related to food, weight, or body shape that meet the criteria for an Obsessive-Compulsive Disorder.

Generally, individuals w/anorexia are compliant. Sometimes, they are overly compliant, to the extent that they lack adequate self- perception.

They're eager to please & strive for perfection. They usually do well in school & may often overextend themselves in a variety of activities. The families of anorexics often appear to be "perfect." Physical appearances are important to them. Performance in other areas is stressed as well & they're often high achievers.

While control & perfection are critical issues for individuals w/anorexia, aspects other than their eating habits are often found to be out of control as well. Many have, or have had at some point in their lives, addictions to alcohol, drugs, or gambling. Compulsions involving sex, exercising, housework & shopping aren't uncommon.

Most of the medical complications of anorexia nervosa result from starvation. Few organs are spared the progressive deterioration brought about by anorexia.

Although not life-threatening, abnormally slow heart action (bradycardia) & unusually low blood pressure (hypotension) are frequent manifestations of starvation & are commonly associated with anorexia.

Of greater significance are disturbances in the heart rate (arrhythmia). A reduction in the work capacity of the heart is associated with severe weight loss & starvation.

Gastrointestinal complications are also associated with anorexia. Constipation & abdominal pain are the most common symptoms. The rate at which food is absorbed into the body is slowed down.

Starvation & overuse of laxatives can seriously disrupt the body's normal functions involved in the elimination process. While liver function is generally found to be normal, there is evidence of enzyme changes & overall damage to the liver.

The glandular (endocrine) system in the body is profoundly affected by anorexia. The complex physical & chemical processes involved in the maintenance of life can be disrupted, with serious consequences.

Disturbances in the menstrual cycle are frequent & can affect not only child-bearing but also bone density growth, which is very important to a woman's health as she ages. Hormonal imbalances are found in men with anorexia as well. Continual restrictive eating can trick the thyroid into thinking that the body is starving, causing it to slow down in an attempt to preserve calories.

Kidney (renal) function may be thought to be normal. However, there are significant changes in many patients, resulting in:

  • potassium deficiency
  • increased urination
  • decreased urination

Anorexics who use a large quantity of laxatives or who frequently vomit are at great risk for electrolyte imbalance, which can have life-threatening consequences.

Anemia is frequently found in anorexic patients. Suppressed immunity & a high risk for infection are suspected, but not clinically proven.

Physical symptoms, other than the obvious loss of weight, can be seen. Anorexia can cause:

  • dry, flaky skin that takes on a yellow tinge
  • fine, downy hair grows on the face, back, arms & legs

Despite this new hair growth, loss of hair on the head isn't uncommon.

  • nails can become brittle
  • frequent vomiting can erode dental enamel & eventually lead to tooth loss

What are anorexia symptoms & signs (physical)?

Most of the medical complications of anorexia nervosa result from starvation. Few organs are spared the progressive deterioration brought about by anorexia.

  • Heart & circulatory system: Although not life-threatening, abnormally slow heart action (bradycardia) & unusually low blood pressure (hypotension) are frequent manifestations of starvation & are commonly associated with anorexia.

Of greater significance are disturbances in the heart rate (arrhythmia). A reduction in the work capacity of the heart is associated with severe weight loss & starvation.

The rate at which food is absorbed into the body is slowed down. Starvation & overuse of laxatives can seriously disrupt the body's normal functions involved in the elimination process. While liver function is generally found to be normal, there's evidence of enzyme changes & overall damage to the liver.

  • The glandular (endocrine) system in the body is profoundly affected by anorexia. The complex physical & chemical processes involved in the maintenance of life can be disrupted, with serious consequences.

Disturbances in the menstrual cycle are frequent & can affect not only fertility but also bone density growth, which is very important to a woman's health as she ages.

Hormonal imbalances are found in men with anorexia as well. Continual restrictive eating can trick the thyroid into thinking that the body is starving, causing it to slow down in an attempt to preserve calories.

  • Kidney (renal) function may appear normal. However, there are significant changes in kidney function in many people with anorexia, resulting in potassium deficiency, increased urination, or decreased urination.
  • Anorexics who use a large quantity of laxatives or who frequently vomit are at great risk for electrolyte imbalance, which can have life-threatening consequences.
  • Anemia is frequently found in anorexic patients. Suppressed immunity & a high risk for infection are suspected, but not clinically proven.
  • Physical symptoms, other than the obvious loss of weight, can be seen. Anorexia can cause dry, flaky skin that takes on a yellow tinge. Fine, downy hair grows on the face, back, arms & legs.

Despite this new hair growth, loss of hair on the head isn't uncommon. Nails can become brittle. Frequent vomiting can erode dental enamel & eventually lead to tooth loss

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How is anorexia treated?

Treatment of anorexia must focus on more than weight gain. In fact, weight gain should be secondary to the more serious underlying issues facing the anorexic.

Some individuals recover fully after a single episode.

Some experience a fluctuating pattern of weight gain followed by a relapse.

Others experience a progressively deteriorating course of the illness over many years & still others never fully recover.

As w/many other addictions, it takes a day-to-day effort to control the urge to relapse.

There are a variety of treatment approaches. Treatment typically depends primarily on the resources available to the individual.

For those individuals whose weight loss has become so severe or has seriously impaired other body systems, hospitalization may be necessary.

Because of increasing insurance restrictions, many patients find that a short hospitalization followed by a day treatment program is an effective alternative to longer inpatient programs.

Most individuals, however, initially seek outpatient treatment involving psychological as well as medical intervention.

Patients can be treated by a medical doctor, a clinical psychologist, or both, depending upon the progression of the disorder. A psychiatrist w/both medical & psychological training is perhaps the best treatment provider.

An appropriate treatment approach addresses underlying issues of control & self-perception.

Family dynamics are explored & often the family is included in the treatment plan.

Nutritional education provides the patient a healthy alternative to weight management.

Group counseling or support groups often assist the individual in the recovery process.

The ultimate goal of treatment should be for the individual to accept themself & lead a physically & emotionally healthy life.

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Anorexia Nervosa At A Glance

(in review of what has been covered)

  • Anorexia nervosa is an eating disorder & more importantly, a psychological disorder.

  • Anorexia affects females far more often than males.

  • People w/anorexia tend to show compulsive behavior.

  • The extreme dieting & weight loss can lead to grave medical problems.

  • Potential problems include heart rhythm disturbances, abdominal abnormalities, anemia, hormonal & electrolyte imbalance.

  • The treatment of anorexia must focus on more than weight gain.

  • Weight gain should be secondary to concern for the more serious underlying issues.

  • Some individuals recover fully after a single episode of anorexia.

  • Others experience a fluctuating pattern of weight gain followed by a relapse.

  • Still others experience a progressively deteriorating course over many years & never fully recover.

  • As w/many other addictions, it takes a day-to-day effort to control the urge to relapse.

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Children & Eating Disorders...
 
Children Learn from What They Hear & See
By Abigail Natenshon


As a parent, you must first become an astute observer of your child. unbiased, open & knowledgeable about what you're looking for & what you're seeing.

In addition, you're your childs best teacher & most significant role model & influence in creating a healthy body image. To become the most effective observer, teacher & model for your child, it's critical that you become aware of your own eating patterns & responses, your own attitudes towards weight & size.

By becoming more highly sensitive to yourself, your personal biases, issues & own bodily care, you become better able to clarify & refine the messages you wish to communicate to your child about how to love his or her body.

In addition, should there be a need to affect change in your childs attitudes about weight, size, body image, or eating patterns & habits, beginning this process w/ changes in ones own self is always the most effective & productive strategy.

More effective than confrontation, control, or power plays is setting a good example, thereby inspiring the child to do what you do & to want what you want for him or her. When it comes to parents & kids, actions consistently speak louder than words.

As you consider the following questions, remember that there are no right or wrong answers, no clear & definitive best ways to be, or best things to do. There's only the attempt to continue learning & deepening your understanding of who you are so you can be the best parent you can be to your child.

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Defining your own relationship w/ food.

What Does Your Child See?
  1. Do you consistently skip breakfast or grab a cup of coffee & call it a meal?

  2. Do you substitute diet drinks, or other supplements for meals? Do you drink Slim fast? Eat Power Bars in the place of a real meal?

  3. Do you make it a point to eat only lite or fat free items?

  4. Do you unequivocally refuse to bring junk food into you house, even if not on a regular basis?

  5. Do you consistently try on numerous items in your closet before finding anything that looks decent on you?

  6. Are you extreme about how often or how long you exercise?

What Does Your Child Hear?

  1. Do you complain about how fat you look all the time?

  2. Do you talk about your guilt for eating fattening foods?

  3. Do you criticize others for their appearance? Do you criticize your child?

  4. Are you intolerant of individual differences?

  5. Do you make running pejorative commentary about actors & actresses on television, in the media, because of the way they look?

  6. Do you encourage your child to lose weight by restricting food, rather than by eating differently?

  7. Do you order fish (Hold the butter.) & salad (Hold the dressing.)?

For the most part, we eat to satiate hunger, to nourish & grow our bodies & to enjoy a sense of community & celebration. None of us are perfect. Most of us, at different times & w/ different motivations, eat for emotional reasons.

We under eat; we overeat; at times we eat to diminish anxiety, ward off depression, or to fill time. There's nothing precise about our bodily needs, nor what we need to feed it. as long as, for the most part, we're eating nutritionally dense or healthy foods, in the form of at least 3 meals per day & making varied food choices.

In the end, there are no bad foods. Healthy eating is the capacity to eat everything, anywhere, at any time, as long as we eat in moderation & w/ a sense of balance & as long as physical activity becomes an enjoyable & regular part of our lives.

This is the critical message that we must convey to our children, thru our words & thru our actions.

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Childhood Fears Take New Form: Body Image Concerns
In Young Children

By Abigail Natenshon


  • From his viewing chair, a father criticizes a television personality for "how fat she looks" in her evening gown.

  • A brother speaks disparagingly about his girlfriends hip size, claiming she needs a "license for the wide-load."

  • The father of a 5 year old tells her jokingly that she'll develop a "Buddha belly" if she puts butter on her bread.

  • A child states that more important than getting A's in school is being accepted by the "popular group." Her parents make no comment.

The vulnerable child is quick to take in & personalize what are otherwise meant to be benign "throw away" comments. Harmful messages get transmitted to children unintentionally & may result in body image disturbances.

As early as the 1st grade, children are reporting concerns & preoccupation w/ weight & body shape & begin to restrict food. Camp counselors report 6 & 7 year olds studying nutritional labels on food items as they empty their lunch sacks. A U.S. Dept. of Health & Human Services task force reports that 80% of girls in grades 3 - 6 have bad feelings about their bodies, an issue diverting attention from schoolwork & friendships.

Preteen boys as well, inspired by the world of sports & television, fret about the inadequacy of their builds, believing that the strength in their muscles or the girth in their chests is more important than intelligence, compassion or emotional well-being.

Believing that outward appearance is a reflection of inner quality, children w/ body image concerns develop a sense of who they are (physically & emotionally) & how they should behave by internalizing messages about themselves from others.

Children lacking self-esteem & who seek acceptance & approval are particularly sensitive & susceptible to the perceptions of parents, family, peers & the media. Body image concerns may be precursors to eating disorders. Even when they don't lead to clinical disease, however, they deserve attention so the child can learn to enjoy a healthful relationship w/ food.

Parents may contribute to the problem
Parents may inadvertently & unwittingly contribute to their childs body image issues. Disparaging or critical parental messages sent to a child about his or her appearance may create or reinforce body image concerns, as well as a lack of self-acceptance, poor self-esteem & food fears & obsessions.

When parents harbor unresolved weight-related & body image issues of their own, these issues may be passed down to children as a legacy, from generation to generation. One study showed that anorexic mothers raised children who by age 5 whined more, demonstrated eating problems & manifested signs of depression.

Children learn best by example, overhearing their parents complain about their own weight & need to diet, watching them restrict food or exercise excessively. Kids are quick to pick up on the signals of parents who skip meals, purchase & eat only lite or fat-free foods, or who don't consider it a priority to prepare & provide 3 meals a day & to sit down to eat them together w/ their family.

Poignant messages are also communicated by what parents choose not to do & to say. When parents don't actively refute poor values or misconceptions in their children, they may find that they're perpetuating & reinforcing them; if they fail to actively negate the childs belief that popularity & peer acceptance is as important as learning & academic achievement, the childs own worst fears & misconceptions are realized & validated.

If not part of the solution, parents are in danger of becoming part of the problem.

Parents are confused
Bombarded by conflicting media messages about how to stay fit & live long, parents have become increasingly food phobic & in many instances, as confused as their children;

  • Many parents have forgotten what healthy eating & living is & isn't. They assume that fat-free eating is healthy eating, that skipping meals is a short cut to being trim. They don't realize that an eating or exercise lifestyle that works well for a parent, when taken out of the context of age & health requirements, doesn't necessarily apply to children & in fact may harm them.

As an example, children need fat in their diets to complete their neurological development throughout the childhood & adolescent years.

  • When parents fear that by communicating honestly with their children about uncomfortable subjects they could create more problems or lose their childs love, they may be inclined to pretend not to notice when their child's in trouble. A problem can't be resolved unless & until it's identified & confronted.

  • Too many or too few parental limits imposed during the growing up years deprive children of the opportunity to internalize appropriate controls thru which they can ultimately regulate themselves.

The overly controlled child who feels victimized & helpless, as well as the overly controlling child who feels overwhelmed & frightened by her own power may experience an emerging internal image of herself as destructive & without limits.

This child may eventually feel the need to turn to an eating disorder to compensate for her lack of external & internal controls; nature abhors a vacuum.

A 3 year old who refuses to put on her snowsuit in a sub-freezing Chicago winter wont allow her mother to belt her into her car seat & ultimately refuses to sleep in her own bed, wandering into her parents room every night.

With a legacy of adult obesity & addiction in her family's genetic pool, this child is a prime candidate to develop an eating disorder in the future.

What parents can do:

  • Model a healthy relationship with food.

  • Educate children, teaching them to regard the body as a wise & predictable machine requiring fuel & maintenance rather than as an object of beauty; food as a life-sustaining fuel rather than as the enemy; healthy eating as a balanced & moderated lifestyle rather than as an exercise in food restriction. 

  •  Listen to know their child & to help their child understand herself. When the child makes negative comments about her shape or size, parents must not dismiss them even if they seem irrational; rather, they should start a discussion about how your child thinks she could look better & why.

  • Help the child develop immunity to the steady stream of media messages that distort her perspective by teaching her to become a more critical consumer of the media & by canceling subscriptions to fashion magazines.

  • Become aware of their body image concerns & attitudes that may stimulate their childs fears, distortions & misconceptions. Parents must be careful not to complain about their own weight.

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When Very Young Kids Have Eating Disorders
By Abigail Natenshon

Although anorexia nervosa usually develops during adolescence, a disturbing number of cases have been appearing in young  (sometimes very young) children.

According to eating disorders specialist Barton J. Blinder, M.D. anorexia has been observed in children as young as 4.  He cites a Mayo Clinic study of 600 patients of all ages, which found that 3% were prepubescent anorexics.

In a suite101.com article (Ellison, January 2000) entitled Childhood Anorexia, Dr. Blinder noted that children, most of whom are girls, have less body fat than their adolescent counterparts, so they become skeletal more quickly.  He argues that a 15% weight loss, rather than the usual 25, should be a criterion for diagnosis.

Childhood-onset anorexia can delay puberty, growth & breast development.

Parents are largely responsible for shaping a childs body image & eating lifestyle.  Mirror-Mirror webmaster Colleen Thompson believes that parents who're themselves preoccupied with body image & weight increase the ranks of childhood anorexics

Dr. W. Stewart Agras cited a study that showed that children of anorexic mothers were already more depressed, whiny & eating dysfunctional by age 5.

Along these same lines however, enlightened parents who are good communicators & sensitive to the childs developmental stage can do a great deal to prevent eating disorders even in the face of a childs genetic or environmental susceptibility. 

What parents should do:

  • First, rule out medical & psychological illnesses.

  • Create a healthy eating lifestyle at home & expect your child to participate within it. Offer your child healthy foods, prepare at least 3 nourishing meals a day; be sure to eat those meals together with your child & family as often as possible. Your child learns by imitating your behaviors.

  • Never skip meals.

  • Keep your lifestyle active & expect your child to do the same.  If children are too sedentary, turn off the television & encourage activity.

  • Spend quality time with your child.  Read together; go for walks.

  • Become aware of your own personal attitudes about eating, body image & weight control.  Do you encourage your son to eat so that he can grow big & strong, yet caution your daughter against becoming fat?

  • Never force your child to clean her plate, giving her a sense of not being in control of her own food.  The parent should determine the menu & the child should determine the amounts of food consumed.

  • Don't criticize your own or your childs weight, shape or size.

  • Don't tolerate casual derogatory comments about other peoples weight & physical appearance. Children take to heart & personalize what you say.

  • Be aware of how your current responses to your childs problem may be affecting your childs behavior & feelings.

  • Encourage your child to become aware of her feelings & to express them freely.  Communicating thru the use of words diminishes the odds that anxious feelings will be expressed thru food-related behaviors.

  • Remember that too much of a good thing is no longer a good thing. Don't allow your child to overdo athletics or dance activities. Food restriction, the use of hormones & extreme workouts aren't uncommon practices for participants in certain competitive sports.

  • Be involved & aware of what the coach or teacher is requiring of  the team & your team & be prepared to step in where you believe things have become extreme & therefore, unhealthy.

A recent study (Davison, Earnest, Birch;  Participation in Aesthetic sports; International Journal of Eating Disorders April 2002 pgs. 315-316) demonstrates that in comparison  to girls who participated in non-aesthetic sports or no sports, girls who participated in aesthetic sports reported higher weight concerns at ages 5 & 7 & girls who participated in aesthetic sports at ages 5 & 7 reported the greatest concern about their weight at age 7.

If you believe a problem exists, be certain to seek out professional help.  When kids are young, going for treatment yourself & or with your spouse or partner first, is always a good place to start. In some instances, that alone might be enough to adjust whatever might be troubling your child.

It's reported that among persons suffering from Eating Disorders, that as many as 85% have been victims of sex abuse.

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Anorexia Nervosa in Children

Anorexia nervosa has been reported beginning at age 4. Childhood anorexia should fulfill criteria for adolescent or adult onset anorexia nervosa, except that in children, due to a diminished amount of body fat, a 25% weight loss isn't necessary.

In female childhood cases, primary amenorrhea occurs.

The incidence of prepubertal anorexia nervosa is 3% in a series of 600 consecutive patients of all ages evaluated for anorexia nervosa at the Mayo Clinic (5).

Females comprise 73% of all reported children w/anorexia nervosa (4).

However, in one subgroup of anorectics (see below), 50% were males (6).

Developmental antecedents of childhood anorexia haven't been systematically research (7). Delaney & Silber (8) evaluated approximately 30 cases & noted lack of stage specific negativism at age 2, anxious clinging behavior upon commencement of school, & difficulty maintaining peer relations, leading to a degree of social isolation.

In infants ages nine to 29 months, Chatoor & Egan (9) described a developmental disturbance which they consider to be both a separation disorder & a form of infantile anorexia. These infants were noted to have a diminished growth rate & food refusal.

Feeding became a battleground for maternal-infant autonomy struggles. The infants resisted feeding as a manifestation of their independence from an overwhelmingly strong maternal figure.

The child's fight for independence thru anorexic behavior is sharply contrated to the listless marasmic pattern that characterizes the withdrawn underfeeding in anaclitic depression (10).

Latency-age children, at the Piagetian stage of concrete thinking, conceptualize food & water together as one entity, resulting in global ingestive restriction. This may lead to rapid weight loss & serious dehydration.

In addition, prepubertal children, especially girls, have less body fat than their adolescent counterparts & become more quickly emaciated (11). In Irwin's series, over 2/3 of the children w/ anorexia were hospitalized within 6 months of the onset of the anorexia.

Gislason (4) noted one death in 33 children w/ prepubertal anorexia nervosa.

Sargent (6) described 3 subgroups of prepubertal anorectics.

The first group, similar to one described by Pugliese et al. (12) severely restricted their food intake, resulting in short stature. They had fears of becoming obese & by their deficient weight gain they maintained both a physical & psychological immaturity.

The second group consisted primarily of prepubertal females, ages 10 to 12, who were psychologically pseudo-precocious, engaging in overt behavior more characteristic of that of a pubescent 14 year-old.

However, they were described as being "lost little girls" underneath this facade. Their parents discouraged age-appropriate behavior & strongly encouraged their pseudo-adolescent behavior. This female subgroup is closet to the pubertal-onset anorexia nervosa.

The third subgroup consisted of an equal number of male & female anorectics who were more psychologically impaired, having major ego deficits w/ the occasional prescence of psychotic episodes (13).

Gislason (4) noted premorbid personality characteristics of:

Significant disturbances of ego development, prepsychotic personality traits & psychotic episodes have been reported (4).

However, these studies were completed prior to the more precise DSM III diagnostic criteria. Moreover, premorbid eating disturbances, including a history of being a finicky eater, have been noted (11).

Family patterns in childhood anorexia nervosa haven't been systematically studied.

Family structural characteristics found in adolescent anorexia nervosa, consisting of:

  • rigidity
  • lack of conflict resolution
  • triangulation

appear to be present in the families of children w/ the disorder (11).

In childhood anorexia, Sargent (6) noted increased divorce among families, as contrasted to adolescent anorexia where the family divorce rate is approximately equal to the general population.

The clinical manifestation of childhood anorexia nervosa should fulfill most DSM III criteria. However, since prepubertal children, especially girls, have less body fat than their adolescent counterparts, a 15% reduction in body weight should be sufficient for diagnosis (11,14).

These children, while recognizing that they're thin, deny feeling fat. It's unclear if there's a body image distortion equivalent to that of older anorectics.

Furthermore, no systematic comparative studies in children have been undertaken. The child may be more concerned w/ separation individuation issues than fears of sexuality (11,15). They frequently demonstrate alexithymia, the inability to translate one's feelings into words (16).

Overt or covert seduction or sexual abuse may be found in the histories of some patients, although Bruch (17), Blinder (18) & Piazza (19) question this hypothesis.

Sloan & Leichner (20) reported childhood sexual abuse in a number of adult patients w/ bulimia nervosa. Oppenheimer et al. (21) reported that 2/3 of 78 eating disorder patients spoke of distressing sexual experiences as a child, including sexual abuse. However, the significance of a history of sexual abuse for the occurrence of anorexia nervosa remains unclear.

Many children with anorexia nervosa manifested signs of depression. These feelings may be the result of helplessness & ineffectiveness internally perceived & mirrored from family attitudinal reactions.

Studies reported prior to DSM III did not utilize structured interviews such as Kiddie SADS. In child anorectics, no formalized studies specifying biochemical, diagnostic, or family criteria for major depressive disorders have been reported.

While anorexia nervosa has been considered a variant of affective disorder (22,23), the relationship between childhood anorexia nervosa & affective disorder must still be clarified.

Anorexia nervosa has been associated w/ Tourette's Syndrome (stereotyped movement disorder) (24,25,26) w/ Turner's Syndrome, a chromosome disorder w/ XO genotype & gonadal dysgenesis (27) & w/ mental retardation (28).

Piazza (19) reported anorexia nervosa in association w/ childhood ulcerative colitis & ileitis. The patient manifested typical bowel symptoms w/diminished appetite & only upon careful questioning was the diagnosis of anorexia nervosa determined.

One child had anorexia nervosa & abdominal complaints which initially masked colitis.

The etiology of childhood anorexia is uncertain. Irwin (11) feels dynamics in childhood anorexia nervosa are similar to the dynamics of adolescent onset & include:

  • identity disturbance
  • failure of separation/individuation w/ fears of growing up
  • maladaptive attempts to be in control
  • failure of parents to resolve marital or family conflicts

An alternative pattern may include a child who is sensitive to family food preoccupation & identifies w/ a family member who has an eating disturbance.

Precipitating events associated with the onset of childhood anorexia nervosa include:

1) the birth of a sibling

2) bereavement over the death of a parent or relative

3) a disappointment in object relations

4) family discord

5) viral illness

6) peer criticism about being fat

7) the fear of becoming obese

8) the onset of breast development

9) sexual abuse

10) sustained fear of choking while eating

11) anticipated fear of parental loss related to an ill or depressed parent

12) the onset of a psychophysiologic disorder such as ulcerative colitis (4).

In the treatment of the childhood anorectic, the therapist should work closely w/ a pediatrician to rule out medical & psychological conditions producing anorexia. A physical examination & laboratory studies are mandatory to monitor starvation effects which include:

1) hypotension

2) syncope

3) bradycardia

4) hypothermia

5) dry skin

6) lanugo hair

7) diminished triceps skin-fold thickness

8) hypoglycemia

9) hair loss

10) sensitivity to noise

11) leukopenia

12) fatigue

13) cardiac arrhythmia

14) electrolyte disturbance

15) hypothalamic dysfunction

16) diminished thermoregulation

17) hypercortisolism

18) vasopressor regulation

19) gastric ulcer

20) initial motoric hyperactivity

Starvation can cause psychological & cognitive disturbances including:

Children, especially those restricting both fluids & food, may need immediate hospitalization. A children's inpatient psychiatric unit can be effective in resolving both physiologic & psychological problems (15,30).

The dietician must determine the appropriate caloric intake for the child. Calories & nutrients not ingested due to food refusal must be supplemented by liquid intensive formula per mouth, or by tube feeding if necessary.

Parenteral hyperalimentation is rarely necessary for childhood anorexia.

Most children's psychiatric inpatient unit use flexible behavioral modification approaches to weight gain. Unlike adolescent or adult behavioral programs, children should be allowed to attend all ward activities regardless of specific weight gain (15).

Overactivity on the ward must be monitored & controlled to avoid weight loss. Panikar (31) used a wheelchair to restrain a severely overactive child. The schizoid, withdrawn child can be rewarded w/points, tokens, etc., for engaging in verbally expressive social interaction.

More intensive involvement of the family in the therapeutic pain may have to await medical stabilization & emerging data concerning developmental history, effects of separation (positive & negative) & family strengths & liabilities.

Play therapy using projective techniques can be useful. While children ages 10 thru 12 may feel too old for play therapy, they may not be cognitively prepared for verbal therapy. They may also be resistant in therapy; therefore, therapeutic creativity is needed. Panikar (16), noting alexithymia, draws smiling faces & asks the children to identify various moods.

Affective expression can be encouraged, such as in Gardner's "Thinking, Talking & Feeling Game" (32). Lucas (33) finds art therapy to be particularly effective when compared to play therapy which the anorectic child often resists & obscures.

Feinstein (34) alternating both male & female therapists, recognizes that the child can work thru separate conflicts w/different therapists.

Sargent (6) modifies treatment according to the 3 anorexic subgroups described above.

In the first group of anorectics, w/ growth retardation described by Pugliese et al. (12) the social worker & nutritionist meet on a regular basis to improve caloric intake. Pugliese uses a cognitive approach, informing the children that they need to eat to be strong & grow.

In Sargent's (6) second group of precocious females, individual psychotherapy explores the child's underlying separation, identity & sexual conflicts  & her need to recognize feelings of ineffectiveness & confusion. The parents must recognize their need to push their daughter into premature adolescence & must work with a dietician to promote normal caloric intake.

In the third group, the therapist must assist the child in recognizing his own sense of worth & must establish a strong therapeutic alliance encouraging normal ego development, interpreting, countering & ameliorating what may be a chaotic enviornment in the family. The parents, often having severe psychopathology, need to resolve their own conflicts  to stabilize the family.

With such a family setting, a period of hospital separation may be a beneficial opportunity for clarification, intensive therapeutic focus on the child & emergency of diagnostically significant elements of family psychopathology masked by the dramatic nature of the child's anorexia.

Chatoor (35), in her treatment of infantile anorexia, uses 10 food rules, including restricting a specific meal time to 30 minutes & refraining from emotionally laden comments. The goal is to allow the infant to reexperience hunger in a neutral, time-limited setting. In some cases, the mother may need to work thru her own internal conflicts (9).

The prognosis in childhood anorexia is unclear. Sargent feels that the group II females have less individual & family psychopathology & have the most favorable outcome as contrasted to group III, since both individual & parental psychopathology are severe.

The group I prognosis is intermediate between groups II & III. Delaney & Silber (8) noted male anorectics w/ a poor prognosis & reported that many families have been resistant to follow-up. Gislason (4) summarized & reported cases of prepubertal anorexia & noted that 63% improved, 21% didn't improve & 3% died.

Russell (36) found prolonged delay of puberty (a late menarche) & possible permanent interference w/ growth in stature & breast development in children w/ prepubertal anorexia nervosa. In contrast, Pfeiffer, et al (37), noted relatively minimal growth retardation on a several-year followup of treatment.

He stresses the importance of identifying childhood anorexia nervosa & returning the children to an optimum weight to safeguard their puberty. A long-term followup is necessary to accurately determine prognosis.

Anorexia nervosa has been reported in prepubertal children, many of whom appear to be more disturbed than adolescents with the same disorder. The precise etiology is uncertain, but life events centering on losses & separation may be onset factors.

Due to less body fat & ingestive restriction of both food & water, this disorder may be more ominous in children, necessitating a rapid & vigorous therapy & frequently requiring inpatient treatment. Prognosis is guarded & uncertain.

Furthermore, coexistent medical illnesses, colitis, or ileitis require careful physical examination & diagnostic procedures & comprehensive integrated treatment & management.

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What is bulimia?

Bulimia, also called bulimia nervosa, is another eating disorder. Bulimia is characterized by episodes of secretive excessive eating (bingeing) followed by inappropriate methods of weight control, such as:

  • self-induced vomiting (purging)

  • abuse of laxatives

  • diuretics

Like anorexia, bulimia is a psychological disorder. It's another condition that goes beyond out-of-control dieting.

The cycle of overeating & purging can quickly become an obsession similar to an addiction to drugs or other substances.

The disorder generally occurs after a variety of unsuccessful attempts at dieting
.

Bulimia isn't as obvious as anorexia, but is actually more common. It affects at least 3% to 10% of adolescent & college age women in the US. Approximately 10% of identified bulimic patients are men.

Bulimics are also susceptible to other compulsions, affective disorders, or addictions. Unlike anorexics, bulimics experience significant weight fluctuations, but their weight loss is usually not as severe or obvious as anorexics.

The long-term prognosis for bulimics is slightly better than for anorexics, & the recovery rate is felt to be higher. However, many bulimics continue to retain slightly abnormal eating & dieting behaviors even after the recovery period.

The secrecy of bulimia stems from the shame that bulimics often attach to the disorder. Binge eating isn't triggered by intense hunger. It's a response to depression, stress, or other feelings related to body weight, shape, or food. Binge eating often brings on a feeling of calm or happiness or euphoria, but the self-loathing because of the overeating soon replaces the short-lived euphoria.

Often, the individual will feel an impairment or loss of control during the binge eating & the purging becomes a way of regaining control. Not all bulimics engage in self-induced vomiting or the misuse of laxatives, diuretics, or enemas during the current episode. Some may fast for days following a binge episode. Others may resort to excessive exercise as a method to regain their control & rid their body of the possible weight gained during the binge.

Excessive exercise is that which interferes w/normal daily activities or when it occurs at inappropriate times or in inappropriate settings, or when it continues despite illness or injury.

What causes bulimia?

As w/anorexia, there's currently no definite known cause of bulimia. Because of the complexity of the disorder, researchers within the medical & psychological fields continue to explore its dynamics.

Bulimia is generally felt to begin w/dissatisfaction of the person's body. The individual may actually be underweight, but when she looks in a mirror she sees a distorted image & feels heavier than she really is. At first, this distorted body image leads to dieting. As the body image in the mirror continues to be seen as larger than it actually is, the dieting escalates & can lead to bulimic practices.

In certain neurological or medical conditions, there can be disturbed eating behavior, but the essential psychological feature of bulimia, the extreme concern w/body shape & weight, isn't present.

Overeating is a common feature in depression. These individuals, however, don't engage in inappropriate weight loss behaviors & don't exhibit the overconcern with body image & weight loss that's characteristic of the bulimic.

Organic causes for bulimia haven't been identified, but are under investigation. Other studies have shown that the affected individual's family has a tendency toward obesity, but this hasn't been definitely established.

How is bulimia diagnosed?

As w/anorexia, denial & secrecy complicate the diagnosis of bulimia. The individual usually doesn't come to the attention of the practitioner until an associated medical condition or serious psychological problem manifests itself. Truthful disclosure of behaviors is critical for an accurate diagnosis. The actual criteria for bulimia nervosa are found in the American Psychiatric Association's Diagnostic & Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV).

There are 5 basic criteria in the diagnosis of bulimia:

  • Recurrent episodes of binge eating. This is characterized by eating within a 2 hour period an amount of food that is definitely larger than most people would eat during a similar period of time & under similar circumstances.

  • In addition to the binge eating, there's an inappropriate compensatory behavior in order to prevent weight gain. These behaviors can include self-induced vomiting, misuse of laxatives, diuretics, enemas or other medications, fasting, or excessive exercise.

  • Both the binge eating & the compensatory behaviors must occur at least 2 times per week for 3 months & must not occur exclusively during episodes of anorexia.

  • Finally, the behavior above is unduly influenced by body image.

The DSM-IV also identifies 2 subtypes. The purging type regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas. The nonpurging type engages in other inappropriate behaviors, such as fasting or excessive exercise, rather than purging methods.

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What medical complications can bulimics have?

The medical complications that result from bulimia are generally due to continual binging & purging. The type of purging behavior used can have varied effects on different body systems.

Self-induced vomiting can result in oral complications.

Repeated exposure to acidic gastric contents can erode tooth enamel, increase dental cavities & create a sensitivity to hot or cold.

Swelling & soreness in the salivary glands (such as the parotid glands in the cheeks) from repeated vomiting can also be a concern.

The esophagus & the colon are the areas most affected by bulimic behaviors. Repeated vomiting can result in ulcers, ruptures, or strictures of the esophagus. Acid that backs up from the stomach (reflux) can also become a problem.

There are a number of intestinal & systemic complications. The misuse of diuretics can create an abnormal buildup of fluid - edema. Continual use of laxatives can result in dependency on them & can cause the normal elimination process to become dysfunctional.

Loss of normal colonic function can necessitate surgical intervention in some cases. Restoration of normal bowel function may take weeks after the misuse has been discontinued. The misuse of diuretics & laxatives combined can place the bulimic at great risk for electrolyte imbalance, which can have life-threatening consequences.

The complex physical & chemical processes involved in the maintenance of life can be disrupted w/serious consequences by the continuation of bulimic & purging behaviors. Additional complications can affect an unborn fetus of a practicing bulimic or the infant of an active bulimic mother. Psychological problems can escalate to serious levels if untreated & interfere w/the restoration of normal body functions.

How is bulimia treated?

Patients w/bulimia present a variety of medical & psychological complications which are usually considered to be reversible thru a multidisciplinary treatment approach. Treatment can be managed by either a physician, psychiatrist, or in some cases, a clinical psychologist. The extent of the medical complications generally dictates the primary treatment manager.

A psychiatrist, with both medical & psychological training, is perhaps the optimum treatment manager.

Some patients may require hospitalization due to the extent of the medical or psychological complications. Others may seek outpatient programs. Still others may require only weekly counseling & monitoring by a practitioner.

Stabilization of the patient's physical condition will be the immediate goal if the individual is in a life-threatening state. The primary goals of treatment should address both physical & psychological needs of the patient in order to restore physical health & normal eating patterns.

The patient needs to identify internal feelings & distorted beliefs that led to the disorder initially.

An appropriate treatment approach addresses underlying issues of control, self- perception, & family dynamics. Nutritional education & behavior management provides the patient w/healthy alternatives to weight management.

Group counseling or support groups can assist the patient in the recovery process as well. The ultimate goal should be for the patient to accept herself & lead a physically & emotionally healthy life. Restoration of physical & mental health will probably take time & results will be gradual. Patience is a vital part of the recovery process. A positive attitude coupled w/much effort on the part of the affected individual is another integral component to a successful recovery.

Bulimia At A Glance
(in review of what was just covered)

  • Bulimia (also called bulimia nervosa) is a psychological eating disorder.

  • Bulimia is diagnosed according to 5 basic criteria.

  • There are 2 types of bulimia: the purging & nonpurging types.

  • The purging type regularly engages in self-induced vomiting or the misuse of laxatives, diuretics, or enemas.

  • Bulimia can have serious medical complications.

  • The successful treatment of bulimia is often multidisciplinary involving medical & psychological approaches.

Overeating vs. Binge Eating

by Toby D. Goldsmith, MD
October 19, 2006

About one-third of all Americans are overweight, and not all of them are binge eaters. Most of us find ourselves eating too much at one time or another. At Thanksgiving, or other special occasions, it is very common for us to consume 1,000 or more calories at a sitting, and often to continue eating even after we feel full. Often we feel we have made a bit of a pig of ourselves. But that does not mean that every American has binge eating disorder.

What separates overeating from binge eating disorder is:

  • The binge eating episodes occur regularly, at least twice a week for six months.
  • The binge eater finds the episodes very upsetting. If there is no emotional upheaval over the meal, it is not a binge eating disorder.
  • The binge eater does not like to eat in public. To him, eating is a private behavior. To most other people, eating and mealtime is a time to be shared and enjoyed with friends and family.
  • The binge eater does not feel normal physiological cues like hunger and being full. He eats more from emotional cues, such as anger and sadness.

Signs and Symptoms of Binge Eating Disorder

Are any of these true for you?

  • Some days even though I wanted to stop eating, I just could not help myself.
  • Some days I surprise myself with how much food I can eat in just a very short span of time.
  • I feel so horrible and guilty after I realize how much food I have consumed.
  • It seems that every night I go to bed thinking, “Tomorrow I am going to begin my diet.”

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20 Ways to Love Your Body!!
From the National Eating Disorders Association
Compiled by Margo Maine, Ph. D.

  1. Think of your body as the vehicle to your dreams. Honor it. Respect it. Fuel it.
  2. Create a list of all the things your body lets you do. Read it & add to it often. (keeps you motivated)
  3. Become aware of what your body can do each day. Remember it is the instrument of your life, not just an ornament.
  4. Create a list of people you admire: people who have contributed to your life, your community, or the world. Consider whether their appearance was important to their success & accomplishments.
  5. Walk with your head held high, supported by pride & confidence in yourself as a person.
  6. Don't let your weight or shape keep you from activities that you enjoy.
  7. Wear comfortable clothes that you like & that feel good to your body.
  8. Count your blessings, not your blemishes.
  9. Think about all the things you could accomplish with the time & energy you currently spend worrying about your body & appearance. Try one!
  10. Be your body's friend & supporter, not its enemy.
  11. Consider this: your skin replaces itself once a month, your stomach lining every 5 days, your liver every 6 weeks, & your skeleton every 3 months. Your body is extraordinary, begin to respect & appreciate it.
  12. Every morning when you wake up, thank your body for resting & rejuvenating itself so you can enjoy the day.
  13. Every evening when you go to bed, tell your body how much you appreciate what it has allowed you to do throughout the day.
  14. Find a method of exercise that you enjoy & do it regularly. Don't exercise to lose weight or to fight your body. Do it to make your body healthy & strong and because it makes you feel good.
  15. Think back to a time in your life when you felt good about your body. Tell yourself you can feel like that again, even in this body at this age.
  16. Keep a list of 10 positive things about yourself, without mentioning your appearance. Add to it!
  17. Put a sign on each of your mirrors saying, "I'm beautiful inside and out."
  18. Choose to find the beauty in the world & in yourself.
  19. Start saying to yourself, "Life is too short to waste my time hating my body this way."
  20. Eat when you are hungry. Rest when you are tired. Surround yourself with people that remind you of your inner strength & beauty.

 

Don't Weigh Your Self-Esteem.
It's What's Inside That Counts!!

ATYPICAL EATING DISORDERS

Atypical eating disorders are classified in DSM III-R as disorders of eating that do not meet the criteria for a specific eating disorder due to absence of particular clinical criteria (frequency of symptom, clinical sign & in special instances gender or age).

This chapter discusses the presence of anorexia nervosa & bulimia nervosa in children,males & females beyond age 25 & in the elderly are also presented. In addition, cultural presentations of anorexia nervosa in Blacks & Hispanics, anorexia nervosa in neuropsychiatric conditions & eating disorders associated w/ medical conditions,hyperphagic conditions & eating disturbance in various endocrine disorders are also reviewed. Core psychological conflicts, etiologic considerations, precipitating events, prognosis, & treatment specific to these unusual & atypical presentations are also discussed.

It's in the news & additional information!
 

All About Eating Disorders

by Psych Central Staff
August 30, 2006
 

Anorexia nervosa & bulimia nervosa are both eating disorders. Anorexia involves people who intentionally starve themselves when they're already underweight.

Individuals with anorexia have a body weight that's 15% or more below recommended levels (as determined by a standard height-weight table).

People suffering from this disorder have an intense fear of becoming fat, even when they're extremely underweight & are usually unable to perceive their physical appearance accurately.

Many females with anorexia stop having their menstrual cycle (period) for several months, a condition called amenorrhea.

By contrast, persons with bulimia nervosa consume large amounts of food during “binge” episodes in which they feel out of control of their eating. They try to prevent weight gain following such episodes by vomiting, using laxatives or diuretics, dieting or exercising aggressively.

Persons with bulimia, like those with anorexia, are very dissatisfied with their shape & weight & their self-esteem is unduly influenced by their appearance.

To receive a formal diagnosis of bulimia nervosa, an individual must engage in binging & purging (vomiting, etc.) at least twice a week for 3 months. However, less frequent episodes of binging & purging may still be very upsetting & require professional assistance.

Anorexia & bulimia sometimes overlap. A minority of persons with anorexia engage in binge eating or purging. This contrasts with “restricting” anorexics who maintain their low body weight by dieting alone.

If an individual binges & purges, but is 15% or more below recommended weight, then anorexia nervosa is the proper diagnosis.

sad... this is very sad

Understanding Your Body & the Disorder

Both anorexia & bulimia are considered psychiatric disorders that have physical complications.

Both disorders grow out of worries about having too much body fat. This is particularly true of females.

Prior to puberty, boys & girls have about the same percentage of body fat - about 9 to 12%. However, at the end of puberty, body fat has usually doubled in girls, reaching about 25% of body weight, while boys have grown leaner & more muscular.

These dramatic changes in the female body type predispose girls to preoccupation & dissatisfaction with their weight.

Persons with anorexia & bulimia feel driven to reduce their weight, usually by dieting (purposefully restricting their food intake). As such, both individuals must fight against their bodies’ natural hunger signals, as well as other biological factors that control eating & body weight.

The word anorexia means loss of appetite, but it's really a misnomer because anorectic individuals usually are hungry & are preoccupied with thoughts of food. (Nervosa means nervous.)

As weight loss increases & the illness progresses, patients begin to display both physical & psychological consequences, including:

which are a direct consequence of physical starvation. These problems are reversed when anorexic individuals resume eating & gain weight.

Bulimia means “ox hunger,” referring to the large amount of food consumed during binge episodes. Persons with bulimia aren't as successful at dieting as anorexics.

They may successfully deny their hunger & restrict their food intake for several days or weeks at a time. However, sooner or later, often when they feel emotionally upset, persons with bulimia lose control over their dieting.

They begin to eat & can't stop eating until they've stuffed themselves. Such overeating is thought to compensate for the prior caloric restriction. Binge eating may also result from impaired satiety (feelings of fullness).

Many bulimics report that they have trouble feeling full, unless they eat large amounts of food.

bulimia

Who Gets Anorexia Nervosa & Bulimia Nervosa

Eating disorders seem to be most prevalent in industrialized societies, especially those in which thinness is considered the attractive ideal.

About 90 to 95% of the cases of anorexia & bulimia nervosa occur in females. Anorexia usually develops in adolescence, between the ages of 14 & 18, while bulimia is more likely to develop in the late teens or early 20's.

It's estimated that anorexia occurs in about 0.5% of adolescent girls & bulimia in about 1 to 2% although various symptoms & milder versions of these disorders occur in about 5 to 10% of young women.

The large majority of women with eating disorders are white, although in recent years the disorder has been increasing in minority women.

Possible Causes

Several factors
may play a role in the onset of anorexia & bulimia, including a familial predisposition to these disorders, as well as individual personality characteristics.

However, the stage for eating disorders is set by our society’s glorification of thinness & strong prejudice against those who are overweight. The thin ideal is portrayed in the media (i.e., using fashion models & movie stars) & is often linked with social desirability & achievement.

As a result, girls & young women are now dieting in record numbers in quest of a leaner shape.

It should be noted that both anorexia & bulimia nervosa were well-documented before the thinness ideal reached its current state, suggesting that this factor alone isn't sufficient for the onset of an eating disorder.

It may, however, be linked to the increase of cases of both anorexia & bulimia in recent years.

What separates individuals who diet & develop an eating disorder from those who don't experience complications?

Genetic studies have found that anorexia nervosa is 5 times as likely to co-occur in monozygotic (identical) twins than in dizygotic (fraternal) twins or non-twin siblings, suggesting a biological component in the onset of the disorder.

In fact, data suggests an increased risk for both anorexia & bulimia nervosa in 1st-degree biological relatives of an individual with the disorder.

Certain personality characteristics also seem to be associated with these 2 disorders. Such predisposing factors include:

Anorexia nervosa also has been linked to obsessive-compulsive tendencies, such as:

  • a preoccupation with thoughts of food

while mood disturbances, such as:

have been associated with bulimia nervosa.

nicole richie denies having an eating disorder

Triggers

If people are vulnerable to eating disorders, sometimes all it takes to put the ball in motion is a trigger event that they don't know how to handle. A trigger could be something as seemingly innocuous as teasing or as devastating as rape or incest.

Triggers often happen at times of transition, shock, or loss where increased demands are made on people who already are unsure of their ability to meet expectations.

Such triggers might include:

  • puberty
  • starting a new school
  • beginning a new job
  • death
  • divorce
  • marriage
  • family problems
  • breakup of an important relationship
  • critical comments from someone important
  • graduation into a chaotic, competitive world & so forth

There's some evidence to suggest that girls who achieve sexual maturity ahead of peers, with the associated development of breasts, hips & other physical signs of womanhood, are at increased risk of becoming eating disordered. They may wrongly interpret their new curves as "being fat" & feel uncomfortable because they no longer look like peers who still have childish bodies.

Wanting to take control & fix things, but not really knowing how & under the influence of a culture that equates success & happiness with thinness, the person tackles her/his body instead of the problem at hand.

Dieting, bingeing, purging, exercising & other strange behaviors aren't random craziness. They're heroic, but misguided & ineffective, attempts to take charge in a world that seems overwhelming.

Sometimes people with medical problems such as diabetes, people who must pay meticulous attention to what they eat, become vulnerable to eating disorders.

A certain amount of obsessiveness is necessary for health, but when the fine line is crossed, healthy obsessiveness can quickly become pathological.

Perhaps the most common trigger of disordered eating is dieting. It's a bit simplistic, but nonetheless true, to say that if there were no dieting, there would be no anorexia nervosa.

Neither would there be the bulimia that people create when they diet, make themselves chronically hungry, overeat in response to hunger pangs & cravings & then, panicky about weight gain, vomit or otherwise purge to get rid of the calories.

Feeling guilty & perhaps horrified at what they've done, they swear to "be good." That usually means more dieting, which leads to more hunger & so the cycle repeats again & again.

It's axiomatic in eating disorders treatment programs that the best way to avoid a binge is to never, ever allow oneself to become ravenously hungry. It's far wiser to be aware of internal signals & respond to hunger cues early on by eating appropriate amounts of nourishing, healthy food.

excerpt from: Anred.com's website - What Causes Eating Disorders

Eating disorders tied to post-baby blues
Mon May 29, 11:30 AM ET

NEW YORK (Reuters Health) - The risk of postpartum depression is higher among women with binge eating disorder or bulimia nervosa, according to findings from a large study.

The risk of becoming depressed after baby arrives is also higher in women who are perfectionists, the study hints.

The findings, reported in the International Journal of Eating Disorders, are based on evaluations of more than 1,100 women who had each given birth to one or more children.

Dr. Suzanne E. Masseo, from Virginia Commonwealth Univ. in Richmond & colleagues observed that symptoms of depression  during pregnancy, "baby blues," & postpartum depression were higher among women with eating disorders.

Bulimia nervosa raised the odds of postpartum depression more than threefold while binge-eating disorder raised the odds more than twofold.

In fact, "women with eating disorders appear to be at as much, if not greater, risk for developing depression during pregnancy or postpartum as are women with a history of major depressive disorder," Masseo & colleagues report.

They also found that, after correcting for lifetime major depression, postpartum depression correlated with concern over mistakes & doubts about one's abilities.

"These findings suggest that, among individuals who reported symptoms of postpartum depression...the severity of these symptoms may be accounted for by specific aspects of perfectionism, primarily concern over making mistakes."

Masseo's team advises doctors to ask pregnant patients about their histories of eating disorders & assess the features of perfectionism, since these traits help "to identify at-risk individuals & facilitate primary prevention of postpartum depression."

"Given the significant impact that postpartum depression can have on the health of both mothers & their offspring, as well as the effectiveness of treatment, early detection & treatment appear invaluable," they write.

SOURCE: International Journal of Eating Disorders April 2006.

When you're a night eater and you're looking for answers as to why you are eating all night, it's difficult to find encouraging information that's factual.
 
It's difficult to have some kind of disorder that you're afraid to talk to people about because of what they might think about you. Fear even looms when thinking about talking to a professional, both medical & mental health. I felt so afraid and alone. I didn't think that anyone else in the world was getting up all night to eat. Once I found a book titled, Chaotic Eating. I was so excited because it described disordered eating syndromes. That was the closest thing that I ever found to read to what I was experiencing.
 
The whole situation made me feel different than everyone else. My mother would say things that made me feel horrible. She always made comments about my body shape and how it was so difficult to find clothes to fit me.
 
I still don't shop for my own clothes. I can't look in the mirror to try clothes on. I can't force myself to do it. If I try to do it, I'll begin to feel faint, my breathing gets short and erratic, I often feel as though I'll pass out of have a panic attack.
 
When I see myself in the mirror, I can't believe that the overweight person in the mirror is me. I can't believe I weigh as much as I do. I have to go into denial and vow to not look into mirrors. I have to stay in the house to avoid seeing my reflection in store windows and in store mirrors.
 
Most of all... I always think that people are looking at me saying to themselves or to whoever they might be with..."That is so gross! That woman needs to go on a diet... That's so disgusting!" I see a certain look on their faces, I'm sure they're disgusted looking at me.
 
I used to be a very attractive person.... Sometimes I just can't take being so hideous.

Weight Gain Often Doesn't Mean Anorexia Cure

Even After Weight Gain, Addressing Underlying Issues Is Critical

Salynn Boyles
WebMD Medical News

Aug. 18, 2005 - Anorexia nervosa patients who gain weight while being treated often spiral back into the eating disorder. Now new research may shed some light on why relapse rates are so high.

The study shows that women who seemed to be getting better while participating in a hospital-based behavioral treatment program continued to show disturbed eating behaviors when their food intake was not carefully monitored.

Although the women had regained much of their lost weight with treatment & had shown improvements in depression & other psychological symptoms, they ate far fewer calories when given an unrestricted test meal than women without anorexia.

"We saw a lot of psychological changes over the course of hospitalization," researcher Robyn Sysko of the Rutgers University Eating Disorders Clinic, tells WebMD. "But when given more control over their eating, these patients still tended to eat less than they should."

Eating Behaviors Examined

9 out of 10 anorexics are female & most develop the disorder as preteens, teens, or young adults.

Research suggests that 1 in 3 women treated as inpatients for the eating disorder experiences a relapse within 2 years of discharge from the hospital.

Improvements in psychological symptoms & weight have been documented during hospitalization for anorexia nervosa. But it isn't clear whether a similar improvement in eating occurs, Sysko & colleagues write in the August issue of the American Journal of Clinical Nutrition.

To test this, the researchers fed 12 hospitalized women with anorexia & 12 women without eating disorders the same number of calories at breakfast followed by an unrestricted-calorie test meal at lunch.

The test meal consisted of a large strawberry yogurt shake. Study participants were told to drink as much or as little as they liked. The anorexic patients were given the test both early in their hospital stay & later, after they had gained back a good deal of weight.

The nonanorexic study participants ended up drinking about 1/2 of their shakes, taking in approximately 500 calories. Early in treatment the anorexic patients took in about 145 calories at the test meal & later in treatment they took in 240 - still less than 1/2 of that eaten by the women without anorexia nervosa.

During both test meals, the hospitalized patients took in fewer calories than they would have if they had been eating their regular, supervised lunch.

"The fact that these patients didn't show as much improvement in eating behavior as they did in other aspects of their treatment illustrates the importance of continuing care once hospitalization ends," Sysko says.

Follow-Up a Must

National Eating Disorders Association spokeswoman Sondra Kronberg, MS, RD, CDN, couldn't agree more. She tells WebMD that weight gain is only a 1st step in anorexia treatment.

"Restoring someone's weight is certainly a necessary aspect of treatment because a starving brain isn't going to respond well to therapy," she says. "But addressing the underlying emotional issues that led to the disorder & the behavioral issues that make it so hard to get better is also critical. That really can't be done in a month or two of treatment."

Kronberg says these days insurance or other medical coverage rarely pays for hospital stays of much longer than this & that critical follow-up care may not be available. She's director & co-founder of Eating Disorder Associates Treatment & Referral Centers in Westbury, N.Y.

The stakes are high, Kronberg says, because the death rate from anorexia nervosa is greater than for any other mental illness.

"There's a big difference between a hospital program where someone is making the food choices for you & the real world," she says. "In the hospital setting patients can either comply or not comply. Those are their only two choices. But in the real world they face constant choices about food.

And with anorexia, thought processes become so ingrained that what you learn over a few months of treatment may not stack up well to what your brain has been telling you for years."

SOURCES: Sysko, R. American Journal of Clinical Nutrition, August 2005; vol 82: pp 296-301. Robyn Sysko, doctoral candidate, Rutgers University Eating Disorders Clinic, Piscataway, N.J. Sondra Kronberg, MS, RD, CDN, spokeswoman, National Eating Disorders Association; director and co-founder, Eating Disorder Associates Treatment and Referral Centers, Westbury, N.Y. WebMD Medical News: "Women with Anorexia Nervosa Often Relapse."Follow-Up a Must

The Changing Face of Anorexia

Anorexia is getting older - & younger - & not just white & female. What's going on?

By Gina Shaw
WebMD Feature

Think anorexia is a teen disease, or a habit taken up by spoiled, white rich girls? Think again.

White women in their teens & 20's still account for most anorexia cases in the U.S. But experts say women in their 40's & 50's, men, black & Hispanic women & even little girls as young as 8 or 9 years old are showing up in doctors' offices with anorexia, bulimia & other eating disorders.

These folks are hardly the typical profile dating from the 1980's, when movies like The Best Little Girl in the World portrayed the distorted body image & birdlike eating habits of well-off white teenagers & young women in their 20s. Research, too, focused primarily on this group of patients.

Now, experts wonder, what's going on? Are eating disorders on the rise in these populations - or are we finally seeing what's been there all along?

It's a little of both, suggests Diane Mickley, MD, co-president of the National Eating Disorders Association (NEDA, www.nationaleatingdisorders.org) & the founder & director of the Wilkins Center for Eating Disorders in Greenwich, Conn.

"I've done intakes at our center for 25 years & there's no question that our patients are getting older & we have many more middle-aged patients," she says. "Now, this is an illness that starts in adolescence, which burgeoned in the 1970's & 1980's. The majority of patients get better, but some don't & they get older."

Few of these cases indicate a truly new onset of the disease at age 35 or 45. "Instead, it's the resurgence of a disease that they may have had since adolescence. We do see the occasional patient with middle-aged onset of anorexia, but the increase in older patients coming for care is predominantly among those who've had it for a long time," says Mickley.

Nevertheless, many of these women are seeking care for the first time in their 30's, 40's & 50's. Why now?

"For women in their 30's, it may be that they want to have children & it forces them to confront something that might be affecting their fertility," says Doug Bunnell, PhD, past president of NEDA & the clinical director of the Renfrew Center of Connecticut. (Headquartered in Philadelphia, the Renfrew Center operates treatment facilities for eating disorders in several states.)

"In the 40's & 50's, what might spur a re-emergence of the disease & a decision to seek treatment, is often some sort of disruption: divorce, death, cancer or other illness scare, empty nest syndrome - any sort of developmental transition," he adds.

Anorexia Is Getting Younger, Too

As the face of anorexia gets older, it's also getting younger.

"For a long time, kids have talked about weight & being fat or thin at a young age," says Bunnell. "But what we're seeing now is an earlier emergence of actual eating disorder behavior. The research hasn't caught up with what we're seeing clinically, but anecdotally, we're treating girls of 10, 9 & 8 years old with full-blown anorexia nervosa."

One heartbreaking challenge to diagnosing these girls: a key diagnostic criterion for anorexia is the loss of menstrual periods, but more & more of these girls are too young to have even had a first period yet.

Besides age, ethnicity is a telling factor in current cases of anorexia. "For Caucasian & Hispanic girls & women, the rates of anorexia are basically indistinguishable," says Bunnell. "On the other hand, there does seem to be some protective factor from anorexia if you're African-American."

Studies have indeed found very few African-American women with anorexia, compared to white, Asian & Hispanic women. But that doesn't mean that they're free from eating disorders.

"African-American women have been found in some research to have higher levels of laxative abuse for weight control even than white women, which was surprising," says Gayle Brooks, PhD, vice president & clinical director of the Renfrew Center in Florida.

"We see high levels of diuretic use as well." Young black women, in short, are more likely to be "bingeing & purging" than they are to be starving themselves with anorexic behavior.

That, too, may be changing. African-American women do get anorexia. A 2001 study, i.e., found that 2% of African-American women at a large Midwestern university had the disorder. Kaelyn Carson, a 20-year-old college cheerleader & track star from Michigan, died in the summer of 2001 after a 14-month battle with anorexia.

"Whatever sort of protective function comes from being very culturally connected dissipates over time as pressures rise on women of color, as they do white women, to have their self-esteem determined by body size," says Brooks.

She adds, "the protective qualities of culture become much less influential when a young girl goes into a predominantly white environment, where she's assaulted with images & pressure to look a certain way."

Anorexia: Not Just a Woman's Problem

In the mid-1980's, experts believed that women with anorexia outnumbered men by a factor of 10 to one or more. But in 2001, a Canadian study published in the American Journal of Psychiatry found that female anorexics outnumbered males by only 4 to 1.

"There are a number of treatment centers in the country that specialize in treating men & boys with anorexia & they seem to be seeing an increase in demand," says Bunnell. Is that because there's been an increase in male anorexia, or simply because doctors are finally recognizing the disease in men? "It's probably a little bit of both."

In 2003, a BBC survey of child & adolescent mental health specialists in Britain found that nearly 3/4 believed that anorexia is underdiagnosed & not well understood, in males.

What's more, there's no doubt that the pervasive societal pressure about body image has been extended, more & more, to men. For proof, look no further than your nearest magazine stand, where you'll find numerous men's magazines featuring the same kind of unrealistically perfect models that have traditionally been found in Vogue & Cosmo.

"Boys & men are now subjected to increasingly unrealistic expectations about what they should look like & mixed in with the national antiobesity push, we're seeing more & more tension in boys about their physical appearance," says Bunnell.

Cultural Pressures to Blame?

Experts agree that precious little is still understood about anorexia & other eating disorders in "nontraditional" populations, like men, minority groups, older women & younger children.

But many suggest that it might have to do with the pervasiveness of cultural pressures. "We have a culture that is fat-phobic, that has unrealistic notions of how thin a body type ought to be & at what age," says Mickley.

"One of the things we've been trying to figure out is how much these disorders can be attributed to inherent biological factors & how much comes from the culture," says Bunnell. (A growing body of studies point to a strong genetic connection for anorexia.)

"The obvious answer is that it's always both. But these days, the cultural pressure about weight is so high, the focus on obesity is so intense & the culture has broadened so much," he notes. Maybe as the culture has gotten louder & more intense, it exposes more of that latent vulnerability."

Published August 11, 2005.

SOURCES: Diane Mickley, MD, co-president, National Eating Disorders Association & founder/director, the Wilkins Center for Eating Disorders, Greenwich, Conn. Doug Bunnell, PhD, past president, NEDA; clinical director, the Renfrew Center of Connecticut, Wilton, Conn. Gayle Brooks, PhD, vice president & clinical director, the Renfrew Center, Coconut Creek, Fla. "Prevalence of Eating Disorders among African American Women." Journal of Counseling Psychology, January 2001; vol 48: pp 111-116. "Comparisons of Men With Full or Partial Eating Disorders, Men Without Eating Disorders & Women With Eating Disorders in the Community." American Journal of Psychiatry, 2001; vol 158: pp 570-574.

10 "Will-Powers" for Improving Body Image
From the National Eating Disorders Association
Compiled by Margo Maine, Ph. D.

  • 10 times a day, everyday, I'll ask myself: "Am I benefiting from focusing on what I believe are the flaws in my body weight or shape?"

  • I'll think of 3 reasons why it's ridiculous for me to believe that thinner people are happier or "better." I'll repeat these reasons to myself whenever I feel the urge to compare my body shape to someone else's.

  • I'll exercise for the joy of feeling my body move & grow stronger. I'll not exercise simply to lose weight, purge fat from my body, or to "make-up for" calories I've eaten.

  • I'll participate in activities that I enjoy, even if they call attention to my weight & shape. I will constantly remind myself that I deserve to do things I enjoy, like dancing, swimming, etc., no matter what my shape or size!

  • I'll refuse to wear clothes that are uncomfortable or that I don't like but wear simply because they divert attention from my weight or shape. I will wear clothes that are comfortable & that make me feel comfortable in my body.

  • I'll list 5-10 good qualities that I have, such as understanding, intelligence, or creativity. I'll repeat these to myself whenever I start to feel bad about my body.

  • I'll practice taking people seriously for what they say, feel & do, not for how slender, or "well put together" they appear.

  • I'll surround myself w/people & things that make me feel good about myself & my abilities. When I'm around people & things that support me & make me feel good, I'll be less likely to base my self-esteem on the way my body looks.

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Mental illnesses profoundly affect an individual's ability to think, feel & act. They are also very common, affecting as many as 1 in 5 Americans over their lifetimes, irrespective of age, gender, or race. 4% of the Nation's population lives w/severe mental illnesses.

eating disorders usually begin in adolescence or early adulthood & are characterized by gross disturbances in eating behavior.

anorexia nervosa is one of the two main eating disorders with the following characteristics involved:

refusal to maintain body weight over a minimal normal weight for age & height; intense fear of gaining weight or becoming fat even though one is underweight; a distorted body image; & amenorrhea in women 

 bulimia nervosa is the second main eating disorder

persistent overconcern with body shape & weight, recurrent episodes of binge eating, a lack of control over eating behavior during the binges, self-induced vomiting & the use of laxatives, diuretics, strict dieting or fasting, or vigorous exercise to prevent weight gain

are the characteristics involved in this eating disorder

anxiety disorders & major depression significantly co-occur or co-exist with eating disorders

your job - should you accept it - is to:

 educate yourself

explore yourself

examine your emotions & feelings

examine your traumas you may have experienced in your lifetime

consider your health

learn about sleep, diet, exercise & relaxation

apply your new knowledge into your life to eliminate your night eating disorder 

after researching night eating, i finally realized... night eating may be considered a sleep disorder in some cases. either way - i believe that knowing about both eating disorders & sleep disorders, especially the sleep disorders associated w/night eating can help you be educated about what has been happening in your life that is so disturbing.
 
the roots of eating disorders....
to be able to grasp the concept and factors involved with "night eating," i think it's a really good idea to learn as much as you can about all eating disorders, sleep & anxiety disorders as well as depression -

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When Parents Have Eating Disorders
By Abigail Natenshon

Eating disorders aren't just diseases of childhood. Though it's well known that 90% of the 8 million people with eating disorders in America today are under the age of 20, the remaining 10% of the afflicted population has been overlooked & ignored, unidentified & untreated, despite the fact that adults with  eating disorders are becoming an ever-growing reality.

Contrary to popular belief, people don't grow out of these disorders simply because they grow up. When young people bring their unresolved eating & body image issues to their adult years, their functioning becomes compromised in all of their life roles.

Eating Disorders & Parenting

Children learn best thru imitation; parents teach best thru role modeling. It's not hard to see how, thru our parenting, unresolved body image concerns & disturbed attitudes towards eating & weight management are passed down to our children as a legacy from one generation to the next.

With insight & awareness, however, enlightened parents with eating issues of their own can do a great deal to prevent their child from falling into the same troublesome attitudes, beliefs, behaviors & food traps that they know so well.

Eating rituals, obsessive preoccupations with food & body image concerns are central to the eating disordered mind, distracting parents from their need to focus on the childs needs. Children aren't born healthy eaters.

They learn from parents how to eat, how to feel about what they eat, & how to care for their body. Thru being fed by parents & learning to eat & to feed themselves, children learn trust in themselves & others, they become respectful of their bodies & develop self-awareness, self-control, self-esteem & good judgment.

When parents are eating disordered, these important life lessons become a greater challenge for parents to teach & for children to learn. Research has shown that by the age of 5, children of anorexic mothers display a greater incidence of depression, disturbed & restricted eating patterns & whining.

Benign eating quirks, idiosyncratic rituals or disordered eating may be transmitted to children as well; it's not atypical for the otherwise benign quality of such adult behaviors to be passed on to the child in the form of a clinical eating disorder.

One mother commented to her 13 year-old daughter one night over dinner as she ordered dessert that she was about to sin, but she would pay penance the following day by exercising for an additional hour. This mother believes that she lives a healthy eating & exercise lifestyle & doesn't understand how such an innocent comment could be problematic for her daughter who is recovering from bulimia.

On the subject of food & eating, there's a precariously thin line between what is normal & what's not. The distinguishing factor lies principally in the purpose of the behaviors or attitudes for the individual.

When eating behaviors serve emotions rather than appetite, when a person loses the capacity to choose his actions freely & spontaneously based on his own needs & the unique requirements of the moment, behaviors fall into the realm of pathology. There's evidence that the roots of eating disorders lie in genetics, in temperament & personality structure.

Though parents aren't responsible for causing their child's eating disorder, parental beliefs, attitudes & examples set can do a great deal to shape a childs attitudes & may contribute to triggering a childs genetic susceptibility to developing disease.

When Parents Have Eating Disorders

For parents struggling with their own eating disorder or dysfunction, there's typically little time, energy, or financial resources left over for themselves to work on recovery, which can average 5 to 7 years.

Many feel that their needs should take a back seat to those of their children. Even in the most severe cases, hospitalization isn't a viable option for parents who don't have the means to hire round the clock caretakers for their children.

In addition, eating disorders create stresses & strains on a marriage, interfering with all forms of intimacy.

Parents who struggle with an eating disorder in the midst of a growing family typically suffer in silence. The wish to hide their shame from their children & their spouse creates an atmosphere of secretiveness, of dishonesty, of alibis & fear that pervades all spheres of life, even beyond food & eating.

What they don't know can't hurt them,

is the commonly held belief among parents who wish to protect their children from unpleasantness & from developing their own eating disorders. Eating disorders tend to become family secrets that are communally known, however, even when they're not openly acknowledged or discussed.

Actions speak louder than words. Children notice when parents skip meals, restrict calories, purchase only fat-free or lite foods, exercise excessively, ritualize the intake of food, are constantly on diets, depreciating themselves & their appearance.

When children aren't given the tools to understand what they see, they experience guilt & fear, anxiety & stress; in addition, they learn a most damaging & critical life lesson about how not to face & resolve pro